Provider Demographics
NPI:1851484687
Name:PEREZ, JEANNIE ONG (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:ONG
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12255 DEPAUL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2510
Mailing Address - Country:US
Mailing Address - Phone:314-739-2207
Mailing Address - Fax:314-739-2436
Practice Address - Street 1:12255 DEPAUL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-2207
Practice Address - Fax:314-739-2436
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2C47207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL680470Medicare ID - Type Unspecified
B18470Medicare UPIN